Lawrence Memorial Hospital

Lawrence Memorial Hospital, founded in 1921, is a 173-bed hospital in Lawrence, Kansas. Lawrence Memorial Hospital was named one of the Top 100 Hospitals in the

Risk Adjustment Quality Specialist

Location

Missouri + 1 moreAll locations: Missouri | Kansas

Posted

3 days ago

Salary

0

Seniority

Senior

No structured requirement data.

Job Description

Risk Adjustment Quality Specialist

Lawrence Memorial Hospital

Risk Adjustment Quality Specialist Location: Lawrence, KS Employment Type: Full-Time Work Arrangement: Hybrid (Remote/Home-Based with On-Site Meetings) Remote Eligibility: Must reside in Kansas or Missouri Job Description: Something special starts here. You can’t define it, but you know it when you see it: the difference between an average life and the good life. When your cup is full – with joy, purpose and lifelong health – it shows. At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career. From flexible, work-life harmony to competitive pay and great advancement potential, find everything you’re looking for at LMH Health. You'll find everything you’re looking for at LMH Health: - Join a team that cares about the community - Tuition reimbursement to support continuing education - Professional development and recognition - Excellent benefits We’re looking for you. I. JOB SUMMARY The Risk Adjustment Quality Specialist plays a vital role in coordinating and supporting prospective, concurrent, and retrospective reviews to assist with patient care management. The position provides education and facilitates chart retrieval for Health Plan audits and reports. This position requires a comprehensive understanding of Hierarchical Condition Categories (HCC) coding to accurately translate, input, extract, and validate medical record data. This role assists with monitoring quality program performance, including tracking, reporting, and implementation of best practices and program requirements. II. ESSENTIAL JOB RESPONSIBILITIES - Perform comprehensive reviews of patient medical records for documentation consistency and adequacy to identify all appropriate coding based on Centers for Medicare & Medicaid Services (CMS) HCC categories. - Monitor revenue opportunities related to value-based care. - Manage the provider query process to clarify documentation and ensure the completeness and accuracy of patient diagnoses, particularly related to chronic conditions. - Utilize evidence based practices to provide providers with targeted feedback and education on improving documentation and coding accuracy, specifically related to HCC. - Demonstrate analytical and problem-solving ability with regard to barriers in receiving and validating accurate HCC information. - Analyze performance data to identify trends, gaps, and opportunities for improvement. - Maintains intermediate to advanced understanding of claims processing procedures, state and federal regulations, and Medicare Part D requirements. - Utilize coding software to ensure compliance with Medicare, Medicaid, and other payer requirements. - Collaborate with medical staff to clarify documentation and support accurate coding and reimbursement. - Participate in audits, quality reviews, and continuous improvement initiatives. - Educate staff on coding practices and HCC assignments. - Maintain compliance with policies, procedures, and continuing education requirements. - Performs other duties as needed or assigned. III. JOB QUALIFICATIONS Required: - Minimum of 3 years of experience in medical coding or risk adjustment with a focus on Hierarchical Care Conditions, value based care contracts, and accountable care organizations. - Strong knowledge of CMS risk adjustment and quality initiatives, including Hierarchical Condition Categories (HCCs). - Completion of one of the following through AHIMA accredited programs: Certificate Coding Associate, Certificate Coding Specialist, Certified Professional Coder, Registered Health Information Technician, Registered Health Information Administrator OR - Credentialed through AAPC Preferred: - Registered Nurse - Associates or Bachelor’s Degree in Health Information Management - 3M Coding Solution Knowledge Remote Work/Work-from-Home: This position has hybrid work flexibility. This person must live within Kansas or Missouri, and will be required attend on-site meetings, as scheduled. Our Cultural Beliefs - People First - Integrity Matters - Better Together At LMH Health,we value inclusion and diversity. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Related Categories

Related Job Pages

More Compliance Jobs

knoell logo

Senior FIFRA Regulatory Affairs Manager

knoell

Your go-to partner for global regulatory registration!

Compliance3 days ago
Part TimeRemoteTeam 501-1,000Since 1996H1B No Sponsor

• Direct the preparation, implementation, and coordination of regulatory projects for new product introductions • Apply expert knowledge of the FIFRA to register actives and products • Navigate the regulatory landscapes for biologicals • Perform comprehensive data gap analyses and draft waiver requests • Draft and review regulatory labels ensuring compliance • Act as a primary point of contact for North America expertise • Mentor and provide technical guidance to regulatory specialists and managers • Collaborate with global colleagues for alignment of strategies

United States
Baptist Health System, Inc. logo

IRB Regulatory Coordinator

Baptist Health System, Inc.

Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include Baptist MD Anderson Cancer Center, Baptist Heart Hospital, Baptist Neurological Institute and Wolfson Children's Hospital.

Compliance3 days ago

Role Description The IRB Regulatory Coordinator supports the day-to-day operations of the Institutional Review Board (IRB) by coordinating regulatory, administrative, and operational activities that ensure compliance with federal regulations, institutional policies, and ethical standards governing human subject research. This position serves as a key resource for investigators, research staff, and IRB members by: - Facilitating regulatory review processes - Supporting committee operations - Maintaining electronic IRB systems - Promoting continuous quality improvement across the research enterprise The IRB Regulatory Coordinator partners with Research Administration, Compliance, investigators, and hospital leadership to support efficient IRB operations while safeguarding the rights and welfare of research participants. Qualifications - Associate of Arts or Associate of Science degree - Bachelor's degree in Business Administration, Health Administration, or a related field preferred Requirements - Minimum one (1) year of experience with federal regulations governing human subjects research and their application in an IRB environment - Minimum one (1) year of experience supporting or coordinating IRB or research compliance processes - Minimum one (1) year of experience utilizing electronic IRB systems and regulatory documentation practices Company Description Recognized as a top place to work in health care, Baptist Health cares for more patients in Northeast Florida than any other provider, ranking as “most preferred” for more than 30 years. We’re Jacksonville's only locally governed, faith-based, not-for-profit health system and provide a full spectrum of preventive and specialty care through 200+ locations and six hospitals. Our centers of excellence include: - Baptist MD Anderson Cancer Center - Baptist Heart Hospital - Baptist Neurological Institute - Wolfson Children's Hospital

United States
Full TimeRemoteTeam 1,001-5,000Since 1989H1B Sponsor

Role Description The Regulatory Publishing Manager supports document-level regulatory publishing activities within a global Veeva Vault Publishing environment. This role focuses on preparing submission-ready regulatory documents through advanced Microsoft Word formatting, dynamic linking within Veeva, and compliant PDF generation. This position works within submission documents to ensure technical accuracy, formatting quality, and alignment with global regulatory standards. The role partners closely with document authors and regulatory stakeholders to embed quality into source documents, reduce time-to-file, and improve document reusability. This is an evolving environment requiring a self-starter comfortable working with refining templates, checklists, and processes. - Format complex regulatory documents in Microsoft Word to meet submission-ready standards. - Apply structured formatting, hyperlinks, bookmarks, cross-references, and linking best practices. - Convert Word source files into compliant, high-quality PDFs. - Work within Veeva Vault Publishing to manage document workflows and dynamic linking functionality. - Support report-level publishing (e.g., clinical reports, protocols, periodic reports). - Ensure alignment with global regulatory publishing standards and eCTD requirements. - Partner with document authors and SMEs to build quality into Word source documents early. - Provide guidance on submission-ready formatting standards. - Support refinement of evolving submission checklists and templates. - Manage multiple concurrent document priorities independently. Qualifications - 5–7 years of global regulatory publishing experience. - Strong knowledge of eCTD structure and electronic submission requirements. - Experience with Veeva Vault Publishing (direct experience strongly preferred). - Advanced Microsoft Word formatting expertise. - Experience generating submission-ready PDFs. - Ability to work independently in a developing, non–cookie-cutter environment. - Strong attention to detail and quality mindset. - Effective cross-functional communication skills. Requirements - Bachelor’s degree preferred but not required. - Experience supporting global regulatory submissions required. - Experience working in a system transition or evolving publishing environment preferred. Benefits - Contract Length: Through the end of the year, with the chance to extend. - Pay Range: $65/hr. - $75/hr. - Shift/Hours: Monday - Friday. Remote. EST hours.

EST (UTC-5)
$65 - $75 / hour

Role Description The primary responsibility of the compliance specialist is to assist the Compliance Testing Manager with the daily and periodic monitoring, researching, and review of state and federal compliance requirements, acts, and laws. Is predominantly self-directed, self-motivated and receives occasional direction and oversight from the Compliance Testing Manager. - Partner with the Compliance Testing Manager and other Compliance Specialists in administering the Bank’s testing and monitoring schedule. - Assist in the development of testing and monitoring review scope and objective. - Develop test documents and compile work papers that effectively document the completion of test steps. - Complete testing to assess compliance with federal regulatory requirements. - Prepare reports of testing results that clearly communicate findings including identified exceptions and root cause analysis. - Communicate results of transactional testing to the appropriate business units and assist with corrective actions. - Effectively communicate, assist, and advise applicable business units on various state and federal compliance laws and regulations. - Attend seminars, workshops, and conferences on behalf of Bank to expand Compliance Department’s knowledge of new and updated compliance requirements. - Assist in providing information during regulatory examinations and internal or external audits. Qualifications - Thorough knowledge of applicable laws and regulations; Equal Credit Opportunity Act, Home Mortgage Disclosure, Electronic Funds Transfers, Fair Debt Collection Practices Act, Fair Credit Reporting, Real Estate Settlement Procedures Act, Truth in Lending, Truth in Savings, etc. - Research and analyze federal and state regulatory requirements. - Ability to develop and maintain close working relationships with business units and individuals. - Needs to effectively work with Microsoft Office products and other computer software programs. - Organizing priorities and meeting deadlines. - Problem solving and critical thinking skills. Requirements - One to three years of related bank compliance experience. - Bachelor's degree (B. A.) from four-year college or university. - Knowledge and experience in Consumer Protection Regulations including TILA, RESPA, Fair Lending, FCRA, SCRA, HMDA, CRA, Flood and deposit regulations, Reg E, Truth in Savings, Reserve Requirements, Deposit Insurance. - Familiarity with required loan documentation, including but not limited to consumer, installment, commercial and real estate loans. - Excellent presentation, interpersonal, written and verbal communications skills. Computer and Software Skills - Skilled in operation of a personal computer, including Microsoft Word and Excel. - Prior experience, or ability to learn, RiskExec, Salesforce, Encompass. Equal Opportunity Statement Enterprise Bank & Trust is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you need an accommodation in order to apply for a position at Enterprise Bank & Trust please contact Human Resources at hr@enterprisebank.com. Enterprise Bank & Trust is committed to managing our business and community relationships in ways that positively impact our associates, clients, and the diverse communities where we work and live. We are proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, gender identity or protected veteran status and will not be discriminated against on the basis of disability. All employment offers are contingent upon the applicant successfully completing both drug and background check screenings. If you would like more information about your EEO rights as an applicant under the law, please click HERE.

United States